Healthcare Provider Details

I. General information

NPI: 1386888493
Provider Name (Legal Business Name): PETROS KOPTERIDES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 W PITTSBURGH ST
GREENSBURG PA
15601-2239
US

IV. Provider business mailing address

532 W PITTSBURGH ST
GREENSBURG PA
15601-2239
US

V. Phone/Fax

Practice location:
  • Phone: 724-832-4297
  • Fax:
Mailing address:
  • Phone: 724-832-4297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD456862
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: